- Date
- 4/1/2025
- Report number
- CALMS - 00079841
- Type
- Licensing Violation
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to report potential or suspected abuse
- Result
- Substantiated
- Findings
- The findings contained in this report are in response to Condition No. RCFCD24-00266, following the facility's assertion of compliance on 04/01/25. Based on interview and record review, conducted during a site visit on 04/17/25, the facility’s failure to immediately notify the local Department office, or the local AAA, of any incident of abuse or suspected abuse was substantiated for 1 of 1 sampled resident (# 3). Findings include, but are not limited to:
An incident report for Resident 3, dated 04/10/25, indicated s/he had suffered an unwitnessed fall with injury. It further indicated Resident 3 had not been using his/her walker per his/her service plan.
Resident 3's service plan, dated 02/07/25, indicated s/he required a walker while ambulating. Staff 1 (Executive Director) stated the facility had ruled out neglect or abuse but acknowledged the incident report indicated Resident 3's service plan was not being followed. There was no documented evidence the facility reported the incident to the Department or the local AAA, despite their investigation indicating Resident 3's service plan was not being followed during the incident. It was determined the facility failed to immediately notify the local Department office, or the local AAA, of any incident of abuse or suspected abuse. An investigation determined this is a violation of Oregon Administrative Rules.